How do I recognize Lewy Body Dementia?
Lewy Body Dementia is a mixed cortical and subcortical dementia. Typical for this form of dementia is a variable course with good and bad days. It can lead to misperceptions of vision and Parkinson-like symptoms such as trembling of the hands or muscle stiffness.
How do I recognise frontotemporal dementia?
In frontotemporal dementia, the frontal and temporal lobes are predominantly affected, resulting in changes in the areas that are located there: The first thing you notice are changes in personality and drive. It usually begins with disturbances in social behaviour: norms and breaches of rules are ignored and are no longer perceived as such. Later on, there are more and more disorders of memory and orientation.
How do I recognise end-stage dementia?
One speaks of a terminal stage of dementia when a person’s mental abilities have been almost completely lost and this manifests itself as an increasing restriction of bodily functions, which in the end can also lead to death. After how long dementia patients reach this final stage and how long this phase lasts depends on the form of dementia. For example, dementia based on circulatory disorders progresses much more slowly than Alzheimer’s disease does.
In the final stage of dementia, as mentioned above, most of the memory is lost. This process also affects the personality of the patient and many characteristics that used to be inherent in people are lost, which is often very difficult for many relatives. This mental breakdown process is usually followed by the first physical changes.
In most cases, this initially affects the intake of food and an increasing immobility sets in. As patients are usually only lying in bed from this point on, the muscles start to deteriorate, which also affects the chewing and breathing muscles. Thus, the shallow breathing often leads to severe respiratory diseases such as pneumonia. If this physical degradation process continues to increase, basic bodily functions can no longer be maintained and death results.
Diagnosis
In order to recognise dementia, the person affected or their relatives must first notice a change. This should be described to the doctor as precisely as possible. Based on the prevailing symptoms, an attempt can be made to classify dementia into different categories (cortical, subcortical, frontal).
It should be noted that these categories are only descriptions and can have numerous causes. Extensive internal, neurological and psychiatric examinations are of great importance, as well as a blood check of numerous parameters. Since many diseases and also medication can be associated with dementia, it should be recognised whether such a cause is possibly present.
This should be supplemented by a spinal tap, as some diseases leading to dementia can only be detected by this. In addition, it can provide further indications of the presence of a neurodegenerative disease, especially Alzheimer’s dementia. In addition, if dementia is present, an imaging of the head should be performed.
The standard here is an MRI examination; if this cannot be carried out on the affected person due to a pacemaker, for example, a CT examination should be performed. This imaging has two important functions. On the one hand, in about 5% of all dementia illnesses, other, possibly treatable causes of dementia can be discovered in this examination.
Secondly, a more precise classification of dementia can be made on the basis of the image. At present there are no laboratory tests that can reliably detect dementia. The increase in some blood values, for example of certain fats, can provide an initial indication, but these are too unspecific to be able to make a diagnosis.
However, a lot of research is currently being carried out on this subject, in order to be able to detect dementia before the first symptoms appear and possibly take preventive measures. For example, the first laboratory tests for Alzheimer’s are currently being tested in studies which could lead to a diagnosis three years before the onset of symptoms. However, it may be several years before these can be used on a large scale.
Three tests in particular have proven to be particularly useful in the neuropsychological diagnosis of dementia. These tests firstly test whether dementia is present and secondly attempt to classify the severity of the dementia and thus make it comparable. The best-known test is the so-called mini-mental status test, also abbreviated as MMST.
Among other things, it tests memory, concentration, orientation and general speech comprehension. Depending on the performance of the patient, up to 30 points can be awarded. If the value obtained is between 10 and 26 points, dementia can be assumed to be present.
Even lower values indicate the presence of more severe disorders. A further test is the number-connection test, which primarily tests the ability to concentrate. In this test, the respondent is asked to connect numbers on a sheet of paper in ascending order.
The result of this test depends on the time the patient took to solve the task. The third test is the so-called clock-drawing test. As the name suggests, in this test the subject is first asked to draw the numbers on a sheet of paper with an existing circle.
Then the hands should be drawn in at a given time. In most cases this is no longer possible for dementia patients. and dementiaDementiaThere are different abnormalities in the brain depending on the type of dementia, which can be made visible by an MRI.
Probably the most conspicuous sign, which is peculiar to almost all forms of dementia, is the presence of so-called brain atrophy, i.e. the destruction and breakdown of brain tissue. This process causes the total volume of the brain to decrease as the dementia progresses, and the folding of the brain becomes more clearly visible on the MRI. In addition, certain forms of dementia can cause circulatory disorders, which then appear as small infarction areas on the MRI because they absorb less contrast agent than the surrounding tissue.
